1 (14) hand hygiene sop final

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Infection Prevention and Control

Standard Operating Procedure (SOP) Hand Hygiene

1 of 9 - Standard Operating Procedure (SOP) Hand Hygiene

Standard Operating Procedure (SOP) Hand Hygiene

Purpose To ensure that all health care staff understand the importance of hand hygiene in preventing the transmission of infection and to enable staff to know when and how to undertake correct hand decontamination in order to maintain service user, staff and visitor safety.

Target Group All health care staff both directly and indirectly involved in the delivery of care including bank, agency and visiting staff. Staff should receive hand hygiene training both at induction and, where appropriate as part of mandatory update training.

Introduction Hand hygiene performed correctly at the appropriate time remains the most important intervention in the prevention and control of the spread of infections in all health and care environments.

There are two types of micro-organisms found on the hands: Transient micro-organisms are: • lightly attached to the surface of the skin • easily acquired on hands by touch • easily transferred via hands to other surfaces on individuals, equipment and the environment • an important source of cross-infection • easily removed with soap and water followed by drying

Resident Micro-organisms are: • part of the body’s natural defence mechanisms • located in the skin in deep crevices and hair follicles • not easily removed by soap and water alone • reduced in number to safe levels by using antimicrobial products • required to be removed prior to surgery and invasive procedures

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2 of 9 - Standard Operating Procedure (SOP) Hand Hygiene

Standard Operating Procedure (SOP) Hand Hygiene

When to Perform Hand Hygiene There is no set frequency for performing hand hygiene. It is the responsibility of the individual to undertake a risk assessment adhering to the principle of “what have I just done and what am I about to do?”

However, the World Health Organisation (WHO) (2009) identified 5 key moments when hand hygiene should be performed: 1. Before touching a service user 2. Before clean / aseptic procedures 3. After body fluid exposure risk 4. After touching a service user 5. After contact with service user surroundings

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3 of 9 - Standard Operating Procedure (SOP) Hand Hygiene

Standard Operating Procedure (SOP) Hand Hygiene

Choice of Hand Decontamination Products 70% alcohol hand gel or rub – Recommended for routine hand decontamination because it is: • • • • •

Quick and easy to use Highly effective in reducing levels of micro-organisms rapidly Contains emollients so better tolerated by the hands Can be placed directly at the point of care Does not require additional facilities e.g. water, hand-wash basin, towels However alcohol gel/rub is inactivated in the presence of dirt or organic material and is less effective against certain micro-organisms. Residues build up over time and require washing to remove. Alcohol does not have a residual effect and requires frequent application.

Liquid Soap and Water Hand washing with liquid soap and water is the most thorough means of routine hand decontamination: • removes dirt, organic matter and transient flora • should be used when hands are visibly dirty or soiled • use to remove build-up of alcohol gel / rub after every 4 – 6 applications • use when caring for service users with undiagnosed diarrhoea and / or vomiting; with Clostridium difficile infection and during outbreaks of viral gastro-enteritis e.g. norovirus Skin Care Staff that undertake regular and frequent hand hygiene are susceptible to long-term skin changes which can result in chronic damage and changes in the skin bacterial flora. This is particularly likely to occur in those with dry skin conditions such as eczema and dermatitis.

Care of hands is important to avoid hands becoming dry, chapped and sore which could inhibit frequency of hand hygiene. In addition broken skin will harbour micro-organisms which will be difficult to remove and pose a risk of cross-infection.

Jewellery Wrist-watches, jewellery e.g. stoned rings and false nails inhibit thorough hand decontamination and can harbour micro-organisms increasing the possibility of crossinfection. Jewellery should not be worn by staff providing direct care or working in the care environment.

Service User Hand Hygiene Hand hygiene is also important for service users, especially in environments where they are unable to adequately maintain their own personal hygiene.

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4 of 9 - Standard Operating Procedure (SOP) Hand Hygiene

Standard Operating Procedure (SOP) Hand Hygiene Service users should be encouraged and offered the opportunity to decontaminate their hands whenever necessary but in particular at the following times: • • •

After using bedpan, toilet or commode Prior to meal service When for whatever reason their hands have become contaminated

Visitors should also be encouraged to wash their hands with soap and water or alcohol gel / rub and to follow instructions from staff when service users have an infection.

To ensure the efficacy of hand hygiene and protect skin, staff should adhere to the following Do Wear short sleeves or roll up sleeves “bare below the elbow”

Do Not to be Do not wear nail varnish, acrylic or gel products

Keep nails clean and short

Do not wear false nails

Cover all cuts and abrasions with water-proof Do not wear stoned rings dressings (a plain band is acceptable and should be moved up and down the finger when performing hand hygiene to clean underneath) Use liquid soap and wet hands prior to Do not wear wrist watches or bracelets applying soap Rinse hands thoroughly to remove all traces of Do not use nail brushes for routine hand soap hygiene Dry hands thoroughly after washing

Do not use hand wash basins for any other purposes e.g. cleaning equipment, emptying wash-bowls

Apply hand cream from a dispenser to hands Do not use bar soap or service users bar soap regularly to wash hands Wear gloves when in contact with blood or other potentially infectious body fluids Perform hand hygiene before and after wearing gloves

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5 of 9 - Standard Operating Procedure (SOP) Hand Hygiene

Standard Operating Procedure (SOP) Hand Hygiene Hand Decontamination Technique Using Soap and Water Action Wet hands, apply liquid soap Rub your hands together palm to palm to create lather

Rub right palm over back of left hand with fingers interlaced, then left palm over back of right hand, fingers interlaced

Rub hands together palm to palm with fingers interlaced

Rub left fist into right palm, then right fist in left palm

Clasp and rotate left thumb in right palm, then right thumb in left palm

Rotate right finger tips into left palm, then left finger tips into right palm

Rub around each wrist with opposite hands

Rinse hands thoroughly under running water. Turn off tap using elbows or paper towel.

Thoroughly dry hands with paper towels, dispose of towels into a foot pedal domestic waste bin

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6 of 9 - Standard Operating Procedure (SOP) Hand Hygiene

Standard Operating Procedure (SOP) Hand Hygiene Hand Decontamination Technique When Using Alcohol Handrub

Action Apply a palmful of alcohol hand product into a cupped hand then rub hands palm to palm

Rub right palm over back of left hand with fingers interlaced, then left palm over back of right hand, fingers interlaced

Rub hands together palm to palm with your fingers interlaced

Rub fist in right palm, then right fist in left palm

Clasp and rotate left thumb in right palm, then right thumb in left palm

Rotate backwards and forwards right clasped finger into left palm then left finger into right palm

Rub around each wrist with opposite hand

Once all steps have been completed and your hands are completely dry, they are safe

Adapted from: WHO (2009) 5 Moments for Hand Hygiene

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7 of 9 - Standard Operating Procedure (SOP) Hand Hygiene

Standard Operating Procedure (SOP)
 Hand Hygiene Areas of the hand frequently missed when hand hygiene not performed correctly

References Loveday HP, Wilson JA, Pratt RJ et al. (2014) epic3: National Evidence Based Guidelines for Preventing Healthcare- Associated Infections in NHS Hospitals in England. Journal of Hospital Infection Volume 86 Supplement1 (S1-S70) National Institute for Health and Care Excellence (2012) Infection: Prevention and control of healthcare-associated infections in primary and community care. NICE clinical guideline (CG139) London: NICE Wilson, J (2012) Infection Control in Clinical Practice. 4th ed. London: Bailliere Tindall World Health Organisation, (2009) WHO Guidelines on hand hygiene in health care: First Global Patient Safety Challenge clean care is safer care. Geneva: WHO

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8 of 9 - Standard Operating Procedure (SOP) Hand Hygiene

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Infection Prevention and Control Gordon House, Station Road Mill Hill, London NW2 2JU Telephone 020 8906 2777 Fax: 020 8906 2233 www.infectionpreventionsolutions.co.uk

9 of 9 - Standard Operating Procedure (SOP) Hand Hygiene